Short-term mortality and implementation of antiretroviral treatment for critically ill HIV-infected children in a developing country

Cowburn, C.; Hatherill, M.; Eley, B.; Nuttall, J.; Hussey, G.; Reynolds, L.; Waggie, Z.; Vivian, L.; Argent, A.
March 2007
Archives of Disease in Childhood;Mar2007, Vol. 92 Issue 3, p234
Academic Journal
Objective: To describe the short-term outcome of critically ill HIV-infected children with access to highly active antiretroviral therapy (HAART) in a developing region. Methods: Prospective observational study conducted in a paediatric teaching hospital in Cape Town, South Africa. All children admitted to the paediatric intensive care unit (PICU) with suspected HIV infection were screened. Data are n (%) with 95% confidence intervals. Results: Sixty eight of 96 HIV antibody-positive children, median age 3 months, were confirmed HIV-infected. Predicted PICU mortality was 0.42. Fifty one children (75%; 95% CI 65 to 85%) survived to PICU discharge, but hospital survival was only 51% (95% CI 40 to 63%). Limitation of intervention (LOl) decisions were a factor in the majority of PICU and ward deaths. Twenty one PICU survivors (31%; 95% CI 20 to 42%) commenced HAART, and two children were already on treatment. Nineteen children (28%) were considered to be established on HAART after 1 month. Thirteen HIV-infected children (19%; 95% CI 10 to 28%), representing 25% (95% CI 14 to 37%) of all PICU survivors, and 68% (95% CI 48 to 89%) of those PICU survivors who were established on HAART remain well on treatment after median 350 days. Conclusion: The majority of HIV-infected children survived to discharge from PICU, but only half survived to hospital discharge. LOl decisions, usually made in PICU, directly influenced short-term survival and the opportunity to commence HAART. Although few critically ill HIV-infected children survived to become established on HAART, the long-term outcome of children on HAART is encouraging and warrants further investigation.


Related Articles

  • Impact of highly active antiretroviral therapy (HAART) on clinical outcomes of vertically HIV-1 infected children. Palladino, Claudia; Bellón, Jose María; Muñoz, Laura Díaz; Alonso, Dolores Garcia; Muñoz-Fernandez, MaÁngeles // Retrovirology;2008 Supplement 1, Vol. 5, Special section p1 

    Introduction The use of antiretroviral therapy produced a decrease in morbidity and mortality rates in human immunodeficiency virus type 1 (HIV-1)-infected children. Objectives To update a previous epidemiological survey that demonstrated the benefits of HAART on the clinical outcome of HIV-1...

  • Introducing a multi-site program for early diagnosis of HIV infection among HIV-exposed infants in Tanzania. Nuwagaba-Biribonwoha, Harriet; Werq-Semo, Bazghina; Abdallah, Aziz; Cunningham, Amy; Gamaliel, John G.; Mtunga, Sevestine; Nankabirwa, Victoria; Malisa, Isaya; Gonzalez, Luis F.; Massambu, Charles; Nash, Denis; Justman, Jessica; Abrams, Elaine J. // BMC Pediatrics;2010, Vol. 10, p44 

    Background: In Tanzania, less than a third of HIV infected children estimated to be in need of antiretroviral therapy (ART) are receiving it. In this setting where other infections and malnutrition mimic signs and symptoms of AIDS, early diagnosis of HIV among HIV-exposed infants without...

  • Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study. Musoke, Philippa M.; Mudiope, Peter; Barlow-Mosha, Linda N.; Ajuna, Patrick; Bagenda, Danstan; Mubiru, Michael M.; Tylleskar, Thorkild; Fowler, Mary G. // BMC Pediatrics;2010, Vol. 10, p56 

    Background: Scale up of paediatric antiretroviral therapy in resource limited settings continues despite limited access to routine laboratory monitoring. We documented the weight and height responses in HIV infected Ugandan children on highly active antiretroviral therapy and determined clinical...

  • Morbidity, Mortality, and Response to Treatment by Children in the United Kingdom and Ireland with Perinatally Acquired HIV Infection during 1996--2006: Planning for Teenage and Adult Care. Judd, Ali; Doerholt, Katja; Tookey, Pat A.; Sharland, Mike; Riordan, Andrew; Menson, Esse; Novelli, Vas; Lyall, E. G. Hermione; Masters, Janet; Tudor-Williams, Gareth; Duong, Trinh; Gibb, Di M. // Clinical Infectious Diseases;10/1/2007, Vol. 45 Issue 7, p918 

    Background. Recent evidence suggests that decreases in morbidity and mortality in cohorts of adults infected with human immunodeficiency virus (HIV) are showing signs of reversal. We describe changes over time in these characteristics and in the response to treatment among children in the United...

  • HIV And HCV Progression in Parenterally Coinfected Children. England, Kirsty; Thorne, Claire; Castelli-Gattinara, Guido; Vigano, Alessandra; Mehabresh, Mehadi I. El; Newell, Marie-Louise // Current HIV Research;May2009, Vol. 7 Issue 3, p346 

    Shared transmission routes of HCV and HIV mean parenteral HIV/HCV coinfection still occurs, often in resource-limited settings. The extent to which coinfection and treatment impact on morbidity and mortality in HIV/HCV coinfected children remains unknown thus optimal management and treatment is...

  • Cellular and humoral immune responses to a tetanus toxoid booster in perinatally HIV-1-infected children and adolescents receiving highly active antiretroviral therapy (HAART). Ching, Natascha; G. Deville, Jaime; A. Nielsen, Karin; Ank, Bonnie; Wei, Lian S.; Myung Shin Sim; Wolinsky, Steven M.; Bryson, Yvonne J.; Deville, Jaime G; Nielsen, Karin A; Sim, Myung Shin // European Journal of Pediatrics;Jan2007, Vol. 166 Issue 1, p51 

    Background: Human immunodeficiency virus type 1 (HIV-1) infected children treated with highly active antiretroviral therapy (HAART) may develop a significant reduction of plasma viremia associated with an increase in CD4+ T-cell counts. Functional capacity of this reconstituted...

  • Determinants of Highly Active Antiretroviral Therapy Duration in HIV-1-Infected Children and Adolescents in Madrid, Spain, from 1996 to 2012. Palladino, Claudia; Briz, Verónica; Bellón, José María; Climent, Francisco J.; de Ory, Santiago J.; Mellado, María José; Navarro, María Luisa; Ramos, José T.; Taveira, Nuno; de José, María Isabel; Muñoz-Fernández, María Ángeles // PLoS ONE;May2014, Vol. 9 Issue 5, p1 

    Objectives: To investigate the duration of sequential HAART regimens and predictors of first-line regimen discontinuation among HIV-1 vertically infected children and adolescents. Design: Multicentre survey of antiretroviral-naïve patients enrolled in the HIV-Paediatric Cohor,t...

  • EU-Born HIV Study: History in the Making. O'Donnell, Peter // Applied Clinical Trials;Mar2009, Vol. 18 Issue 3, p28 

    The article discusses the continued multinational cohort research on Data Collection on Adverse Events of Anti-HIV Drugs (DAD). The study was designed in collaboration with Europe, Australia and the U.S. to review for cardiovascular safety and metabolic and body composition changes associated...

  • HAART may be effective for HIV epidemic control.  // PharmacoEconomics & Outcomes News;7/24/2010, Issue 608, p4 

    The article discusses research study on the association of highly active antiretroviral therapy, coverage, population viral load and yearly new human immunodeficiency virus (HIV) diagnoses in British Columbia, referencing a study by J. S. G. Montaner and colleagues published in the July 18, 2010...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics